10. Learn to speak ICD-10 before October 1, 2014.
The US is the last nation in the industrialized world to adopt the International Classification of Diseases, 10th Edition. Federal rules mandate the adoption of this coding system by 10-1-14 for all healthcare settings. An educational program for all NSLIJ physicians (employed and voluntary) will be available shortly. Our goal is to make this education convenient, efficient, informative and practically useful on a discipline-specific basis.
9. Make in-roads into the problem of "appropriate use."
This is the 800 lb gorilla of our nation's healthcare system. Abundant evidence supports the view that there is significant variation among physicians in the we way use tests and treatments, that this variation cannot be explained by patient factors, and that for many specific examples "heavy users" do not achieve better outcomes. As a matter of fact, in many instances, the use of non-value added interventions are known to add risk in excess of benefit while wasting scarce resources.
We will be working System-wide to adapt the most promising components of the ACP Foundation's Choosing Wisely campaign for improvement work. Substantial physician leadership will be critical to the success of any such effort.
8. Complete our transition to electronic ordering and note-writing.
The only thing more painful than transitioning to an EMR is lingering in a half-way state which is inefficient and encourages miscommunication and errors. We will be working hard with every department to fully implement electronic documentation during the first months of 2014.
7. Continue to decrease hospital mortality and readmission.
In 2013 we did very well in each of these areas - in '14 we need to sustain the momentum. Risk-adjusted mortality rates are sensitive to (1) a well documented medical record that accurately reflects the patient's acuity; (2) skillful communication about patient-centered options for end-of-life care outside the hospital setting; and (3) attention to many, many care processes so as to limit adverse events related to medications, infections, "failure-to-rescue" and other factors.
Notably, end-of-life care also influences readmission rates, for obvious reasons. A number of improvement programs have also focused on patient education, medication reconciliation and close followup in the community as effective strategies to reduce avoidable readmissions to the hospital.
6. Improve the quality of our conversations with patients about advance directives and other aspects of end-of-life care.
More on this one in my next blog entry. Suffice it to say that expert communication about advance directives and other decisions affecting patients with life-limiting conditions should not be the sole province of Palliative Care specialists. Among the best things we could say about our medical staff would be that we do an excellent job at informing and supporting patients and families when we undertake these very challenging discussions.
5. Begin collecting data for our IRB-approved research project on the use of illness narratives in improving patient and family-centered care and patient experience.
A team of Huntington physicians, nurses and others are working with faculty at the School of Medicine on a project that tests the effects of…an invitation. In this case-control, prospective, single blind study, subjects are invited to share their thoughts about anything they think their doctors and nurses need to know to understand them as individuals. Building on previous work related to "illness narratives" we will be looking at effects on staff, families and patients.
4. Achieve and sustain 100% performance across the CMS process measures for Surgical Care, Heart Failure, AMI and Pneumonia that drive public quality reporting and hospital reimbursement.
Currently, twelve clinical process measures and a similar number of patient experiences measures are collected and publicly reported by CMS. These "value-based purchasing" measures also drive hospital reimbursement. Success in this domain requires excellent coordination among physicians, nurses and quality managers.
3. Ensure that our Medical Staff is in full compliance with the quality and patient safety standards of the Joint Commission.
During 2014, all hospitals in the NSLIJ System will be undergoing surveys by the Joint Commission. This alone is enough reason to pay very close attention to their standards. Additionally, the 1200 plus "elements of performance" provide a detailed and effective roadmap to excellence in domains from medication management to the environment of care. Physician leaders will play an important role in ensuring that we exceed all of the requirements related to orders, chart entries, infection prevention, the avoidance of wrong-site or wrong-patient events, and many other issues.
Although the culture of healthcare is gradually changing, as physicians we continue to face a disconnect with the "process oriented" approach of TJC. For most of us, ensuring good care and good outcomes has been a matter of each practitioner being smart, skillful and diligent. The buck, as it were, stops with us. Current safety culture, by contrast, focuses on the performance of the team. When errors in care occur, the physician's solution is to learn and try harder next time, while a systems-oriented approach has more to do with cross checks and other process changes that make the error harder to make.
2. Complete the integration of the former Glen Cove Family Practice residency into Huntington Hospital.
Most physicians are naturally drawn to teaching. Trainees, whether med students or residents, put a fresh face on clinical issues we have come to take for granted, provide us an opportunity to stretch ourselves, and earn us professional points for "giving back." Patients on teaching services often receive better care because clinical decision are occurring under a spotlight that can catch errors and encourage thinking outside the box.
We have begun integrating the GC Family Medicine residents into our adult Medicine program, Pediatrics, Palliative Care Division, Critical Care and Surgery. The program will be fully staff by around April 1, 2014 and I applaud the many among you who are making this happen.
1. Find ways to promote professional satisfaction among the members of our talented and committed medical staff.
Teaching may be one way to do this. Simply getting obstacles out of your way is certainly another. What are some parts of your day that don't seem to add value for your patients? Can we eliminate them? Let us know what keeps you up at night and what interferes with deriving the most satisfaction possible from the day-to-day care of patients and from being the physician you envision yourself to be. Let's start the conversation.
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